Top

Published in:

01-11-2014 | Original Scientific Report

Time-Based Trauma-Related Mortality Patterns in a Newly Created Trauma System

Authors: Husham Abdelrahman, Ayman El-Menyar, Hassan Al-Thani, Rafael Consunji, Ahmad Zarour, Ruben Peralta, Ashok Parchani, Rifat Latifi

Published in: World Journal of Surgery | Issue 11/2014

Abstract

Background

Data on time-based trauma mortality (TTM) patterns in developing countries are lacking.

Objective

Our objective was to analyze the TTM in a newly established trauma center.

Methods

A retrospective analysis of all trauma-related mortality between 2010 and 2012 was conducted in Qatar. Based on the time of injury, deceased cases were categorized into immediate (pre-hospital), early (first 24 h), and late (>24 h) groups. TTM was analyzed and compared.

Results

A total of 4,966 trauma patients were admitted to the trauma center over 3 years; of them, 333 trauma-related deaths (6.8 %) were documented and reviewed. The death pattern peaked immediately post-trauma (n = 142), followed by 96 deaths within the first 24 h, 19 deaths within the time period >24 to 48 h, 50 deaths within the 3rd and 7th day (second peak), and 26 deaths after the 1st week. The majority of the deceased were males, with a mean age of 36 ± 17 years. Motor vehicle crashes (43.5 %) were the commonest mechanism of injury. At presentation, median injury severity score (ISS) was 32 (range 9–75). Bleeding, abdominal, and pelvic injuries were higher in the early group, whereas head injuries were observed more in the late mortality group. Co-morbidities and in-hospital complications were predominantly encountered in the late group. Head injury (odds ratio [OR] 3.760; 95 % confidence interval [CI] 1.311–10.797) was an independent predictor for late death, whereas the need for blood transfusion was a predictor for early death (OR 3.233; 95 % CI 1.125–9.345).

Conclusion

The distribution of mortality shows a bimodal pattern. The high rate of death at the scene highlights the importance of pre-hospital care and the need for injury prevention programs.

World Health Organization (2001) The world health report 2001: mental health: new understanding, new hope. Geneva, World Health Organization. http://www.who.int/whr/2001/en/whr01_en.pdf Accessed 22 Dec 2013

Lichtveld RA, Panhuizen IF, Smit RBJ et al (2007) Predictors of death in trauma patients who are alive on arrival at hospital. Eur J Trauma Emerg Surg 1:46–51CrossRef

Ker K, Kiriya J, Perel P, Edwards P et al (2012) Avoidable mortality from giving tranexamic acid to bleeding trauma patients: an estimation based on WHO mortality data, a systematic literature review and data from the CRASH-2 trial. BMC Emerg Med 12:3PubMedCrossRefPubMedCentral

Trunkey DD (1983) Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am 249(2):28–35PubMedCrossRef

Kauvar DS, Lefering R, Wade CE (2006) Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 60:S3–S11PubMedCrossRef

Nast-Kolb D, Aufmkolk M, Rucholtz S et al (2001) Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma. J Trauma 51:835–841PubMedCrossRef

Miller PR, Croce MA, Kilgo PD et al (2002) Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg 68:845–850PubMed

Osborn TM, Tracy JK, Dunne JR et al (2004) Epidemiology of sepsis in patients with traumatic injury. Crit Care Med 32:2234–2240PubMed

Chang W, Tsai S, Su Y et al (2008) Trauma mortality factors in the elderly population. Int J Gerontol 2:11–17CrossRef

10.

Sauaia A, Moore FA, Moore EE et al (1995) Epidemiology of trauma deaths: a reassessment. J Trauma 38:185–193PubMedCrossRef

11.

Sobrino J, Shafi S (2013) Timing and causes of death after injuries. Proceedings (Bayl Univ Med Cent) 26(2):120–123

12.

Evans JA, van Wessem KJ, McDougall D et al (2010) Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 34:158–163PubMedCrossRef

13.

Meislin H, Criss EA, Judkins D et al (1997) Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources. J Trauma 43:433–440PubMedCrossRef

14.

Mamtani R, Al-Thani MH, Al-Thani AA et al (2012) Motor vehicle injuries in Qatar: time trends in a rapidly developing middle eastern nation. Inj Prev 18:130–132PubMedCrossRefPubMedCentral

15.

Osler T, Baker SP, Long WB (1997) A modification to the injury severity score that both improves accuracy and simplifies scoring. J Trauma 43:922–926PubMedCrossRef

16.

Association for the advancement of automotive medicine (2011) About AIS. http://www.aaam.org/about-ais.html. Accessed 2 June 2014

17.

Nance ML (2012) National Trauma Data Bank 2012. Annual report. American College of Surgeons. http://www.facs.org/trauma/ntdb/pdf/ntdb-annual-report-2012.pdf Accessed 31 Dec 2013

18.

Gunst M, Ghaemmaghami V, Gruszecki A et al (2010) Changing epidemiology of trauma deaths leads to a bimodal distribution. Proceedings (Bayl Univ Med Cent) 23:349–354

19.

Di Bartolomeo S, Sanson G, Michelutto V et al (2004) Epidemiology of major injury in the population of Friuli Venezia Giulia-Italy. Injury 35(4):391–400PubMedCrossRef

20.

Acosta JA, Yang JC, Winchell RJ et al (1998) Lethal injuries and time to death in a level I trauma center. J Am Coll Surg 186:528–533PubMedCrossRef

21.

Chalkley D, Cheung G, Walsh M, Tai N (2011) Deaths from trauma in London: a single centre experience. Emerg Med J 28:305–309PubMedCrossRef

22.

Lansink KWW, Gunning AC, Leenen LPH (2013) Cause of death and time of death distribution of trauma patients in a level I trauma centre in the Netherlands. Eur J Trauma Emerg Surg 39:375–383CrossRef

23.

Pang JM, Civil I, Ng A et al (2008) Is the trimodal pattern of death after trauma a dated concept in the 21st century? Trauma deaths in Auckland 2004. Injury 39:102–106PubMedCrossRef

24.

Al-Thani H, El-Menyar A, Latifi R (2014) Prehospital versus emergency room intubation of trauma patients in Qatar: a 2-year observational study. North Am J Med Sci 6:12–18CrossRef

25.

Probst C, Pape HC, Hildebrand F et al (2009) 30 years of polytrauma care: an analysis of the change in strategies and results of 4,849 cases treated at a single institution. Injury 40:77–83PubMedCrossRef

26.

Brattström O, Granath F, Rossi P, Oldner A (2010) Early predictors of morbidity and mortality in trauma patients treated in the intensive care unit. Acta Anaesthesiol Scand 54:1007–1017PubMedCrossRef

27.

Ciesla DJ, Moore EE, Johnson JL et al (2005) A 12-year prospective study of post injury multiple organ failure: has anything changed? Arch Surg 140:432–438PubMedCrossRef

28.

Ulvik A, Kvåle R, Wentzel-Larsen T, Flaatten H (2007) Multiple organ failure after trauma affects even long-term survival and functional status. Crit Care 11(5):R95PubMedCrossRefPubMedCentral

29.

McGwin G Jr, Nunn AM, Mann JC et al (2009) Reassessment of the tri-modal mortality distribution in the presence of a regional trauma system. J Trauma 66(2):526–530PubMedCrossRef

30.

Gruen RL, Jurkovich GJ, McIntyre LK et al (2006) Patterns of errors contributing to trauma mortality. Ann Surg 244:371–380PubMedPubMedCentral

31.

Gabbe BJ, Cameron PA, Wolfe R et al (2005) Predictors of mortality, length of stay and discharge destination in blunt trauma. ANZ J Surg 75:650–656PubMedCrossRef

32.

Malone DL, Dunne J, Tracy K et al (2003) Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 54:898–907PubMedCrossRef

33.

Mostafa G, Gunter OL, Norton HJ et al (2004) Age, blood transfusion, and survival after trauma. Am Surg 70:357–363PubMed

34.

Robinson WP III, Ahn J, Stiffler A et al (2005) Blood transfusion is an independent predictor of increased mortality in nonoperative managed blunt hepatic and splenic injuries. J Trauma 58:437–445PubMedCrossRef

35.

Baker CC, Oppenheimer L, Stephens B et al (1980) Epidemiology of trauma deaths. Am J Surg 140:144–150PubMedCrossRef

36.

Shackford SR, Mackersie RC, Holbrook TL et al (1993) The epidemiology of traumatic death. A population-based analysis. Arch Surg 128:571–575PubMedCrossRef

37.

Cowley RA (1976) The resuscitation and stabilization of major multiple trauma patients in a trauma center environment. Clin Med 83:16–22

38.

Pellicane JV, Byrne K, DeMaria EJ (1992) Preventable complications and death from multiple organ failure among geriatric trauma victims. J Trauma 33:440–444PubMedCrossRef

Title: Time-Based Trauma-Related Mortality Patterns in a Newly Created Trauma System
Authors: Husham Abdelrahman
Ayman El-Menyar
Hassan Al-Thani
Rafael Consunji
Ahmad Zarour
Ruben Peralta
Ashok Parchani
Rifat Latifi
Publication date: 01-11-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 11/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2705-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Time-Based Trauma-Related Mortality Patterns in a Newly Created Trauma System

Abstract

Background

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2014

Enhanced Recovery After Surgery Pathway in Patients Undergoing Pancreaticoduodenectomy

Clinical Strategy for the Reconstruction of Middle Hepatic Vein Tributaries in Right Liver Living Donor Liver Transplantation

Early Postoperative Small Bowel Obstruction is an Independent Risk Factor for Subsequent Adhesive Small Bowel Obstruction in Patients Undergoing Open Colectomy

Statement on Surgical Pre-Residency Preparatory Courses

Above 5 cm, Size Does Not Matter Anymore in Patients with Hepatocellular Carcinoma

Lateral Incisional Hernia After Renal Transplantation: A Comparative Study